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General NPI Number Information
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NPI Number | 1528953247
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Entity Type | Organization
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Legal Business Name | ADIA MED OF WINTER PARK LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1561 W FAIRBANKS AVE STE 205
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City | WINTER PARK
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State | FL
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Zip | 32789-4678
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Country | US
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Telephone | 321-231-2843
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Fax |
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Provider Business Mailing Address
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Address Line | 4421 GABRIELLA LN
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City | WINTER PARK
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State | FL
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Zip | 32792-6325
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Country | US
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Telephone | 321-231-2843
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | LARRY POWALISZ
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Credential |
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Telephone | 321-231-2843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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